Ultrasonography in the staging of Hodgkin's disease: lymphangiographic correlation

The contribution of ultrasonography (US) to the staging of Hodgkin's disease was studied in 45 patients. US findings were compared with lymphangiograms (LAG) performed in the same period. In 93% of the patients there was good correlation between the two examinations. In 7% (three patients) there was a discrepancy: LAG showed retroperitoneal node involvement while with US this was negative. There were no false-positive US examinations. We therefore suggest that US be used as the primary method in the initial evaluation of Hodgkin's disease and LAG be performed only when US is negative.

Production of colony-stimulating activity (CSA) by T-chronic lymphocytic leukemia cells

T-lymphocytes are probably involved in regulating myelopoiesis. We show that homogeneous populations of leukemic T-lymphocytes freshly obtained from two patients with T cell chronic lymphocytic leukemia produce colony-stimulating activity. The cells from both patients showed the antigenic and biochemical phenotype of the mature T-lymphocyte of the helper subset. This adds further support to the view that helper T-lymphocytes may regulate hematopoiesis in addition to their role in the immune function.

Transformation of chronic lymphocytic leukemia to plasmacytoma

In a woman with chronic lymphocytic leukemia (CLL), a maxillary plasmacytoma developed after 8 years. The membrane-bound immunoglobulin of the leukemic lymphocytes, the cytoplasmic immunoglobulin of the plasma cells, the serum monoclonal protein and the urine Bence-Jones protein had the same heavy and light chains--mu kappa. This suggests that the leukemic cells transformed to plasma cells. This very rare event is a complete reversal of the more common transformation that occurs in CLL and manifested by de-differentiation. Only in one case out of the 20 previously reported patients with CLL and multiple myeloma there was evidence, like in the current case, of a common clonal origin of the two B-cell neoplasms.

Waldenström's hyperglobulinemic purpura: an unusual immune complex disorder

A case of Waldenström's hypergammaglobulinemic purpura in a 37-year old woman is presented. The symptomatology was very mild and confined only to the skin, despite very high quantities of circulating immune complexes which were found in her serum. The unusual manifestations of Waldenstrom's purpura compared to other immune complex disorders is discussed.

Gene analysis in delta beta and delta (0) thalassemia

Restriction mapping of the globin genes from a homozygous delta beta thalassemia patient from Israel indicates that at least a 10-kilobase deletion is present extending 3' from within the large intervening sequence (IVS 2) of the delta globin gene and including the entire beta globin gene. Unique bands are seen when cellular DNA from this patient is digested with a variety of restriction endonucleases and hybridized with a probe specific for the delta IVS 2. Extensive analysis of the Israeli delta beta thalassemia DNA as well as material from an Italian delta beta thalassemia homozygote with enzymes which cleave more frequently in delta IVS 2 has localized the 5' end of the deletion to a 107-base pair region within delta IVS 2. This region contains a unique repetitive sequence (TG)4 which has been reported to be a specific recognition signal for recombination and may be involved in the formation of these mutant genes. Two homozygous delta(0) thalassemia DNA samples from Japan were also analyzed for gene rearrangements or other changes by restriction enzyme mapping. No changes from normal were seen using 14 different enzymes indicating the absence of large deletions in the region around the delta globin gene. More specifically, both the 5' and 3' splice junctions of the IVS 2 appear to be normal from hybridization of restriction fragments generated by HphI and AluI, respectively, with a delta IVS 2 specific probe. We have also shown that point mutations which could lead to termination codons are not present at codons 35, 37, 43, 61, and 121, since restriction enzymes which recognize these sites produce normal patterns. The delta(0) thalassemia phenotype in these two subjects is most likely due to a point mutation either at one of the other 24 potential termination codons not accessible to restriction analysis or to other single nucleotide changes which could either decrease delta globin gene transcription or lead to abnormal processing or transport of delta globin mRNA.

The epidemiology of childhood acute lymphoblastic leukemia and non-Hodgkin's lymphoma in Israel between 1976 and 1981

n epidemiologic survey of childhood acute lymphoblastic leukemia (ALL) and non-Hodgkin's lymphoma (NHL) occurring in Israel, Judea, Samaria and the Gaza Strip between the years 1976 and 1981, revealed 205 cases of ALL and 69 of NHL. The mean annual incidence of lymphatic malignancies was 3.1/10(5) in the Israeli Jews, 2.3/10(5) in the Israeli Arabs and 2.5/10(5) in the Gaza Strip. In the Jewish population there was a peak in the incidence of lymphatic malignancies at the 2-5 years age group, while in the Israeli Arabs this was less prominent. There were no significant differences in the incidence or type of lymphatic malignancies in the various Jewish or Arab groups but there was a trend for a high leukemia to lymphoma ratio (LLR) in the patients from the Gaza Strip. A relatively higher LLR was observed in families of a high socioeconomic status, but it did not reach statistical significance. T-cell ALL comprised about a third of the typed ALL cases. A high proportion of the patients with ALL belonged to the high-risk category: 46% of the Jewish children and 76% of the Gaza Strip children. White blood cell count above 100,000/mm3 were found at presentation in 36.7% of the Gaza Strip patients but only in 9.4% of the Jewish patients. In spite of that, the survival at 4 years of the Jewish and Arab patients was similar. However, the patients with T-cell ALL had a significantly worse survival than the standard risk or the non-T high-risk group: 43.3 +/- 9.7, 66.6 +/- 7.1 and 63.6 +/- 10.4%, respectively. Compared to a previous study conducted in this country in the sixties it appears that the epidemiologic differences that were observed at that time between the various Jewish ethnic groups have practically disappeared.

Correlation between HbA1c, purified insulins, diabetic control, and insulin antibodies in diabetic children

Insulin antibodies were determined in sera from 38 children diagnosed as having juvenile diabetes for a duration of 0.7-15.2 years (median = 4.9 years). 8 children were treated with purified porcine insulins from the beginning of their disease, 16 children with bovine insulin NPH alone, and 14 children with non-purified, of whom 9 were later transferred to purified insulins. Serum insulin antibodies were measured by non-specific and specific methods using beef (B) and pork (P) antigens as described by Welborne and Sebriakova, respectively. 12/38 children had insulin binding levels similar to those of normal children, irrespective of the type of insulin used. The concentration of antibodies using radiolabelled B or P insulins as antigens were strongly correlated, by both the non-specific (p less than 0.01) and the specific (p less than 0.01) methods. Children with better score for diabetic control had significantly lower levels of insulin antibodies against B (p less than 0.05) and P (p less than 0.05) than those with poor diabetic control. There was also a significant positive correlation between mean HbA1c concentration and both B and P mean insulin antibody concentration (p less than 0.01). Finally, patients treated with purified porcine insulin had significantly lower levels of antibodies than patients with non-purified bovine insulin (p less than 0.05).

Results of treatment of high risk childhood acute lymphoblastic leukemia

Sixteen children with high risk acute lymphoblastic leukemia (ALL) who had one or more of the following risk factors: white cell count over 50 X 10(9)/liter, mediastinal mass, age under 2 or over 10 years, extramedullary involvement, or T-cell markers, were treated by a new protocol. All attained complete remission and 11 are still in their continuous first remission for 6-53 months. High activity of adenosine deaminase (ADA) in the leukemic cells seems to be an independent risk factor, as in the high ADA level group, 4 out of 7 patients relapsed and died, while none of the 8 patients with low ADA levels relapsed or died.

Acute lymphoblastic leukemia subtypes in Israel: the Sheba medical center experience

During the period from 1978 to 1981, 52 patients with ALL were diagnosed and treated at the Chaim Sheba Medical Center. Using standard cell markers to subtype the blasts, 49 of the patients could be classified: 16 were found to be T-cell ALL, 10 common ALL, five null ALL, four pre-B and 14 were partially characterized as non-B, non-T. Analysis of the series revealed two distinctive features: high prevalence (30%) of T-cell ALL among both Jews and Arabs and a high proportion, two-thirds, of high risk patients due to high initial WBC counts, unfavourable age or T-cell characteristics. The minimal incidence of ALL among the Gaza Strip Arab children during the study period is 4:100,000, which is close to the incidence in the Western world. During previous years the leukemia incidence in the Gaza Strip was very low while the most common lymphatic malignancies were Burkitt tumor and other non-Hodgkin lymphomas.

Effect of levamisole, thymic humoral factor and indomethacin on e-rosette formation of lymphocytes in Hodgkin's disease

The percent of E-rosette forming cells in the peripheral blood of 60 patients with Hodgkin's disease was significantly lower than in control subjects: 46.4 +/- 12.3 vs. 62. 4 +/- 12.5. Preincubation of the mononuclear cells with levamisole, thymic humoral factor (THF) or indomethacin restored E-rosette formation to normal levels. When monocytes were removed from the mononuclear cell preparations prior to incubation, levamisole and THF retained their activity, whereas indomethacin was inactive. These results suggest a direct effect of levamisole and THF on lymphocytes in Hodgkin's disease, whereas indomethacin requires the mediation of monocytes, similarly to its reported effects on other cellular immune responses in Hodgkin's disease.

Nucleoside phosphorylase activity in normal and leukemic cells

Nucleoside phosphorylase (NP) activity was assayed in normal peripheral blood lymphocytes, mature and immature thymocytes fractionated by peanut agglutinability, CLL lymphocytes, and ALL lymphoblasts to determine applicability as an enzymatic cell marker. Circulating lymphocytes had the highest activity, immature thymocytes the lowest, and mature thymocytes were intermediate in NP level. This suggests an increase in NP activity with T-cell maturation. CLL lymphocytes showed very low activity, confirming previous reports. However, the NP activity of the lymphoblasts of 40 patients with B, T, and non-B, non-T ALL was similar to that of normal peripheral blood lymphocytes and could not be used to discriminate between these subgroups of ALL.

Adenosine deaminase activity of normal lymphocytes and leukemic cells

Adenosine deaminase (ADA) activity was determined in peripheral blood T cells, thymocytes and blasts of 42 acute leukemia patients. Thymocytes had higher ADA activity than mature peripheral blood T cells. B ALL (acute lymphoblastic leukemia) cells had significantly lower activity compared with T ALL and non-B, non-T cells. The latter had a wide range of enzymatic activities but mostly in the T cell range. Based on these results, as well as on assays of B and T cell lines, it seems that thymus-derived cells--and especially prethymic and immature T cells--have high ADA activity. This finding could be useful in subtyping the heterogeneous group of non-B, non-T ALL.

Serum immunoglobulins in chronic lymphocytic leukemia

Serum immunoglobulin levels were periodically determined in 70 CLL patients and the changes were correlated with several clinical and laboratory parameters. It was found that the IgG and IgA levels decreased significantly as the disease progressed. A low IgG concentration was found at the time of diagnosis in 18.7% and after six years in about 50% of the patients. The IgM concentration, although initially low, increased during the follow-up in 43% of the patients and in four of them a monoclonal fraction appeared in the serum. The changes in the immunoglobulins did not correlate with age, sex or initial leukocyte count. Stage O patients as well as untreated patients also had a decrease in their immunoglobulin levels but advanced disease stage and especially continuous chemotherapy seemed to augment the drop in the immunoglobulin levels. Neither the initial immunoglobulin levels nor the subsequent changes, absolute or relative, had a significant prognostic value.

Role of radiotherapy and chemotherapy in the treatment of lymphomas

The recent developments and results of treatment in Hodgkin's disease suggest that staging laparotomy is indicated in certain selected groups of patients and should not be performed routinely in patients whose therapy is unlikely to be changed by the findings.Early stage nodal Hodgkin's disease is best treated by extended radiotherapy. The exact role of adjuvant chemotherapy is not settled, but there are certain groups of high-risk patients who should receive chemotherapy, such as those with extensive mediastinal disease or advanced IIIA patients. In the advanced stages, chemotherapy assumes the primary role and with the MOPP programme (chlormethine, vincristine, procarbazine, and prednisone), alone or alternating with ABVD (doxorubicin, bleomycin, vinblastine, and imidazole carboxamide), a substantial number of patients can be controlled or cured.The therapeutic approach to non-Hodgkin's lymphoma should be guided mainly by the histological findings, favourable or unfavourable, and to a lesser degree also by the stage of the disease. In these patients, chemotherapy rather than radiotherapy is the treatment of choice. In the favourable histology group, a conservative approach is usually justified in the majority of patients, while in the unfavourable histology group, aggressive combination chemotherapy containing adriamycin is the recommended therapy.In underprivileged populations, the abdominal and intestinal localization of lymphomas is more common than in Europe and North America. Two lymphomas of special interest are Burkitt's lymphoma and intestinal lymphoma in their varying aspects. In both diseases, the importance of environmental factors is highly suggestive. Referral of such patients to centres involved in the management of these diseases is essential.

Ferritin deposits in peripheral blood lymphocytes of Hodgkin's disease patients

In view of the reported associations of Hodgkin's disease and ferritin, an electron microscopic study of the peripheral blood lymphocytes of these patients was done. In 5 out of the 6 patients studied intracellular ferritin deposits were seen. No such deposits were seen in the lymphocytes of healthy subjects or in those of a patient with beta-thalassemia. The lymphocyte ferritin accumulation in Hodgkin's disease can arise either from increased synthesis or from phagocytosis.

Selective splenectomy in Hodgkin's disease, stages I and II. Results of treatment

Sixty-three patients with Hodgkin's disease, in stages I or II, asymptomatic (A) or symptomatic (B), were diagnosed and followed at the Chaim Sheba Medical Center from 1969 to 1976. Only 14 were staged pathologically. Until 1971, the patients received mantle or "inverted Y" therapy only; thereafter, an extended field that included mantle, upper abdomen and spleen irradiation was given. Symptomatic patients, as well as patients with extranodal involvement, received MOPP chemotherapy (nitrogen mustard, vincristine, procarbazine and prednisone) after termination of radiotherapy. Of 51 patients who were in stage IA or IIA, six relapsed 20 to 43 months after irradiation. Three had a pelvic recurrence; two of them were surgically staged. Thus, in only 1 of 51 patients could staging laparotomy possibly have detected pelvic disease and resulted in different therapy. Our results suggest that total nodal irradiation and staging laparotomy are not mandatory in stages IA and IIA of Hodgkin's disease. The group of 12 symptomatic patients is too small to allow us to draw definite conclusions as to the role of staging laparotomy and adjuvant chemotherapy. However, in view of the high relapse rate in the upstaged symptomatic patients, it seems that chemotherapy should be given to these patients.

Extramedullary hematopoiesis with multiple tumor-simulating mediastinal masses in a patient with beta-thalassemia intermedia

A patient with beta-thalassemia intermedia with massive extramedullary hematopoiesis in the mediastinum is presented. These masses, which simulate tumors, are usually asymptomatic only rarely causing spinal cord compression. The histologic examination showed that they consist of hematopoietic tissue. The importance of correct diagnosis without surgery is stressed.

Fluidity difference of membrane lipids in human normal and leukemic lymphocytes as controlled by serum components

Lymphocytes isolated from the peripheral blood of patients with chronic lymphatic leukemia and from normal healthy donors were analyzed for fluidity of membrane lipids. The degree of lipid fluidity in normal and leukemic lymphocytes was quantitatively monitored by a method based on fluorescence polarization analysis of a fluorescent probe that is embedded in lipid regions of cellular membrances. The present studies were performed on lymphocytes isolated from 26 blood samples from 16 patients with chronic lymphatic leukemia and 36 blood samples from 36 normal health donors. A signifcant increase in the degree of fluidity of membrane lipids was found in lymphocytes isolated from leukemic patients as compared to that found for lymphocytes isolated from healthy donors. In vitro incubation of leukemic lymphocytes in normal serum resulted in a decrease in the fluidity of cellular membranes, whereas incubation of normal lymphocytes in leukemic serum resulted in an increase in the fluidity of membrane lipids. These observations suggest that normal and leukemic lymphocytes can be quantitatively characterized by monitoring degree of fluidity of cellular membrane lipids and that the fluidity difference between normal and leukemic lymphocytes is controlled by components in the blood serum.